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Tip: choose "Save as PDF" in the print dialog to download. 2 pages — page 2 is meant to be photocopied per resident.

Page 1 of 2

Nawayalatenna Grama Niladhari Area

House & Resident Data Collection Form

නිවාස හා නිවැසියන් තොරතුරු එකතු කිරීමේ පත්‍රිකාව  /  வீடு மற்றும் குடியிருப்பாளர் தகவல் சேகரிப்பு படிவம்

Please write clearly in BLOCK LETTERS. This is page 1 of 2 — fill house/property details below. Page 2 covers one resident; photocopy it for every additional person living in the house. This form will be entered into the online system later by a village officer.
කරුණාකර පැහැදිලිව ලියන්න. / தெளிவாக எழுதவும்.

A. House / Property Information  / නිවාස තොරතුරු / வீட்டு தகவல்

House (නිවස / வீடு)Office (කාර්යාලය / அலுவலகம்)Shop (කඩය / கடை)Workshop (වැඩමුළුව / பட்டறை)Other (වෙනත් / பிற)
1234+
Aswasuma (අස්වසුම / அஸ்வசும)Samurdhi (සමෘද්ධි / சமுர்த்தி)Elderly Allowance (වැඩිහිටි දීමනාව / முதியோர் படிப்பூதியம்)Disability Allowance (ආබාධිත දීමනාව / ஊனமுற்றோர் படிப்பூதியம்)Other (වෙනත් / பிற)

Office Use Only

Page 2 of 2 — photocopy this page for each additional resident

B. Resident Information  / නිවැසියන් පිළිබඳ තොරතුරු / குடியிருப்பாளர் தகவல்

One resident per copy — write this person's number in the box above (1, 2, 3 …) and photocopy this page for every other resident of the house.

Employed (රැකියාවේ නිරත / வேலையில் உள்ளவர்)Studying (අධ්‍යාපනය / படிப்பில் உள்ளவர்)Retired (විශ්‍රාමලාභී / ஓய்வு பெற்றவர்)Looking for better employment (වඩා හොඳ රැකියාවක් සොයයි / சிறந்த வேலை தேடுகிறார்)Need employment (රැකියාවක් අවශ්‍යයි / வேலை தேவை)No need for employment (රැකියාවක් අවශ්‍ය නැත / வேலை தேவையில்லை)